Daskalov T, Malamov E, Savova A, Urumov G, Kusitasev G
Vutr Boles. 1982;21(4):47-57.
The results from the step-wise loading test to 75 per cent of the age maximum pulse rate, performed by veloergemeter or thread-mill in 52 patients (9 females and 43 males, II of them with atypical chest pain and II with stenocardia) were juxtaposed to the data from the selective coronarography. It was established that the a reduction of ST segment greater than I mm and the appearance of precordial pain, degree III by the five-grade scale, have almost identical specificity (70% and 64% resp) and a predicting value of the positive result (68% and 70% resp) and a slightly higher sensitivity to pain (68% and 84% resp) in the detection of coronary stenosis greater than 50 per cent of the diameter of a main coronary vessel. The combination of the signs precordial pain degree III and/or ST reduction greater than I mm and/or elevation of ST greater than 2 mm, with same predicting value (67%) maintained, but with a considerably enhanced sensitivity (96%) proved to be most adequate as a criterion of the positive test. A reduction of ST segment greater than 22 mm is characterized by decrease of sensitivity (40%) but with a considerable increase of specificity (96%). The positivation of that sign suggests the presence mainly of a multibranch disease. The patients with coronary stenosis greater than 50%, rarely reach a physical capacity over 100 wt (7 x oxygen consumption) and a product of the maximum reached pulse rate and systolic blood pressure over 20 000 as compared with those without stenosis, but no difference among the patients with one-branch and multi-branch disease was established. The electrocardiographic changes in the patients with a true positive test with loading is more often retained after 4th minute of the rehabilitation phase as compared with those of the patients with false-positive test. Evidence exists to admit that the predicting value of the positive test is poorer in the patients with atypical pains and females.
对52例患者（9例女性，43例男性，其中11例有非典型胸痛，2例有狭心症）使用功率计或跑步机进行逐步负荷试验，使其达到年龄最大脉搏率的75%，并将结果与选择性冠状动脉造影的数据并列比较。结果表明，ST段压低大于1mm以及心前区疼痛（五级量表中的III级）的出现，在检测主要冠状动脉血管直径狭窄超过50%时，具有几乎相同的特异性（分别为70%和64%）、阳性结果预测值（分别为68%和70%），且对疼痛的敏感性略高（分别为68%和84%）。心前区疼痛III级和/或ST段压低大于1mm和/或ST段抬高大于2mm的体征组合，预测值相同（67%），但敏感性显著提高（96%），被证明是最适合作为阳性试验标准的。ST段压低大于2.2mm时，敏感性降低（40%），但特异性显著增加（96%）。该体征阳性主要提示存在多支病变。与无狭窄患者相比，冠状动脉狭窄超过50%的患者很少能达到超过100瓦（7倍耗氧量）的体力，且最大心率与收缩压的乘积很少超过20000，但单支病变和多支病变患者之间未发现差异。与假阳性试验患者相比，负荷试验真阳性患者的心电图变化在康复期第4分钟后更常持续存在。有证据表明，非典型疼痛患者和女性患者的阳性试验预测值较差。
